Provider Demographics
NPI:1841430972
Name:WHITE, ANDREA (LAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1118
Mailing Address - Country:US
Mailing Address - Phone:610-606-8033
Mailing Address - Fax:
Practice Address - Street 1:200 EAGLE RD STE 30
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3115
Practice Address - Country:US
Practice Address - Phone:610-606-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000959171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist